The primary goal of anterior lumbar fusion surgery (ALIF) is to relieve pressure on either the nerve roots or spinal cord and/or treat an unhealthy disc in the lumbar spine through a surgical approach through the front of the body.
The anterior lumbar fusion is performed with a general or vascular surgeon to help with exposure. A 2–3-inch transverse incision is made on the lower abdomen. The anterior organs and blood vessels require some retraction to gain access to the spine. Dr. Paul then uses an instrument to remove the disc and restore normal alignment to the spine. A cage filled with material engineered to grow bone. This may be cadaver bone and/or other materials like bone morphogenic protein.
The cage is specifically sized to restore as much normal alignment as possible. Dr. Paul typically plans for potential sizes and realignment before surgery. He also uses live intraoperative technology to monitor realignment during surgery as well.
Dr. Paul will sometimes apply screws and/or a plate to help fix the cage in place. Depending on your situation, he may have to perform surgery from the back as well.
Your implants are MRI compatible and are not known to set off metal detectors.
Approximate surgical times is 60-90 minutes for one level, and 75-100 minutes for two levels. We must emphasize, these are approximate times. These times are much higher if you have had prior surgery on your spine.
Please allow an additional 1½ to 2 hours if there is additional surgery required from the back.
Remember, there is substantially more time involved in putting you to sleep, prepping and draping prior to surgery, and more time required to wake you up. As a result, many additional hours are required. Time required to go to sleep, wake and recover can vary from two to three hours. Most of the variability is in the post-anesthesia recovery unit.
Dr. Paul typically calls the waiting room to update a family member or friend about you briefly. Kevin or Sienna will typically check on you in the recovery room and speak to the nurse and Dr. Paul about your recovery. Nursing will let your family know when they can see you.
Making arrangements before surgery helps ensure all necessary steps are taken and allows you to focus on recovery.
Information to help you arrive on time for your procedure and to better understand the process on procedure day.
After surgery, you can expect some pain. Your surgeon and the staff will use every reasonable measure to help.
Explore Dr. Paul’s approach to long-term recovery, focusing on tailored treatment plans and ongoing support.
We strongly recommend implementing the use of MyDMGHealth to contact the office. Our staff monitors the messages during business hours.
We have attempted to define the more common risks of surgery under each of the procedures outlined. It is impossible to outline all potential poor outcomes, but we have attempted to do so in good faith. It has not been formed as legal protection for us, only to better inform you. Please read them thoroughly.
Infections are a known complication of lumbar surgery. Infection rates are more associated with smoking, poorly controlled diabetes, obesity, and other health factors. Less invasive and shorter procedures also have lower complication rates. Infections requiring additional surgery are extremely rare in Dr. Paul’s practice.
Bleeding can be a serious complication since blood accumulation can compress the spinal cord or nerve roots. For that reason, we require discontinuing blood thinners, some anti-inflammatories and all herbal medications.
Spinal Leaks are a known complication in spine surgery but typically can be managed. They occur approximately 3 to 5% of the time They can be the result of adherent bone, disc, ligament or scar tissue to the dura and the membrane surrounding your nerves or spinal cord. They are far more associated with revision surgery, severe nerve compression and advanced age. If this occurs, we typically repair the leak during your operation. You may be required to lay flat for a short period of time afterwards. Late presenting or persisting spinal leaks can require additional surgery. Spinal leaks typically do not affect long term outcomes.
Neuropraxia & Nerve Injury nerves under pressure can react with pain or increased weakness after being decompressed. These issues are expected and usually resolve with treatment or time. The goal of fusion is to realign and improve the position of the spine which can cause some nerves to be stretched and also induce typically temporary changes. Rarely, these changes are permanent As a precaution, Dr. Paul utilizes a state-of-the-art nerve and spinal cord monitoring system to avoid neurologic problems.
Non-Union - Not all fusions heal. Some heal as early as three months, but many take longer. Some fusions require a year to heal. Dr. Paul’s team gets x-rays regularly during the first year and meets with you to make sure the fusion is successful. Some fusions will require revision surgery to fix the problem.
Medical Complications related to the heart, lung and kidneys and other organs are also a possibility. Although shorter less invasive procedures are associated with lower complication rates, they can still occur. We work closely with your primary care doctor and other specialists to make sure your medical conditions are optimized prior to surgery.
Thigh Weakness – The Procedure requires the surgeon to dilate and retract tissues in a muscle that allows you to raise your leg and flex your hip. It is not unusual to have some temporary weakness and numbness in this area. It can occasionally be more pronounced and last longer.
